Methenamine is an important drug for the prevention of lower urinary tract infections. It can hydrolyze into formaldehyde in an acidic urine environment (pH≈6.5) and exerts a broad-spectrum bactericidal effect. The U.S. Food and Drug Administration has approved methenamine hippurate(MH) for the prevention of recurrent urinary tract infections in patients aged 6 years or older. This article reviews the epidemiological status and challenges in the prevention and treatment of MH, and systematically elaborates on the research progress in the prevention and treatment of urinary tract infections with MH, aiming to provide a reference for the more rational and effective clinical application of MH in this field.

Objective: To analyze the pharmaceutical care process of a patient with Candida parapsilosis bloodstream infection, explore the risk factors, diagnostic methods and treatment regimens of the infection, and provide a reference for improving clinicians' and pharmacists' understanding of the disease and their collaborative diagnosis and treatment capabilities. Methods and Results: A 67-year-old male patient had undergone stent implantation for the anterior descending branch and circumflex branch of the coronary artery in another hospital due to "chest tightness for 5 years, aggravated for more than 2 months", and took secondary prevention drugs for coronary heart disease regularly after surgery, but still suffered from intermittent chest tightness and anhelation. He was transferred to Guizhou Provincial People's Hospital on November 20, 2023. On admission, electrocardiography showed third-degree atrioventricular block, and dual-chamber permanent pacemaker implantation was performed. After surgery, the patient suddenly lost consciousness, suffered from respiratory and cardiac arrest, and was immediately given tracheal intubation and invasive mechanical ventilation. Echocardiography showed a small amount of pericardial effusion, and central venous catheterization was performed. Considering the patient had hemorrhagic cardiac tamponade, thoracotomy and hemostasis exploration were carried out immediately. Postoperatively, the patient was in moderate to severe coma with no response to pain stimulation. On December 6, the patient underwent tracheotomy and was transferred to the Coronary Care Unit after surgery. From December 14 to 15, fungal spores were detected in the patient's blood cultures (aerobic + anaerobic) for two consecutive times, and caspofungin acetate for injection was administered for antifungal treatment. On December 17, the blood culture results indicated Candida parapsilosis (the strain was sensitive according to drug susceptibility test results). On December 18, the patient's clinical symptoms and signs still showed no significant improvement. Based on his condition and evidence-based data, clinical pharmacists suggested combined use of amphotericin B for injection and formulated an individualized dosage regimen. On December 26, the clinical team adopted the pharmacists' suggestion, titrated the dose of amphotericin B for injection to 45 mg per day, and successfully removed the right internal jugular vein catheter under strict aseptic technique. Through the above interventions and full-course pharmaceutical care, the patient's infection was gradually controlled, clinical symptoms were significantly improved, and the treatment achieved favorable efficacy. Conclusion: Effective management of Candida parapsilosis bloodstream infection is a systematic project integrating accurate etiological diagnosis, rational application of antifungal drugs, complete elimination of infection sources and comprehensive pharmaceutical care throughout the treatment process. Clinical pharmacists play an important role in optimizing anti-infective treatment regimens.

Objective: To analyze the pharmaceutical care process of postoperative intracranial infection treatment in a patient with intracranial space-occupying lesion, and provide a reference for clinical treatment. Methods and Results: A 45-year-old male patient was admitted to the hospital due to "left temporal lobe space-occupying lesion". On the 11th day after admission, he underwent resection of intracranial space-occupying lesion in the left frontotemporal region, and cefazolin was given for infection prevention before surgery. On the first day after surgery, the patient's body temperature was 37.4 ℃, with significant elevation in white blood cell (WBC) count and neutrophil (NEUT) count, and the medication was switched to ceftriaxone sodium. On the third day after surgery, the patient had low-grade fever (body temperature 37.8 ℃) with abnormal results of cerebrospinal fluid examination, and intracranial infection was considered. Clinical pharmacists conducted consultation, suggested discontinuing ceftriaxone sodium and switching to the combined regimen of vancomycin (loading dose 1.75 g, maintenance dose 1 g, intravenous drip, q12h) + vancomycin (20 mg, intrathecal injection, q24h) + meropenem (2 g, intravenous pump infusion for more than 3 hours, q8h). The proposal was not fully adopted by physicians, and the patient was treated with vancomycin (loading dose 1.75 g, intravenous drip, q12h) + vancomycin (40 mg, intrathecal injection, q24h) + meropenem (1 g, intravenous pump infusion for more than 3 hours, q8h). On the 6th day after surgery, the patient's body temperature rose to 3⁹.3 ℃. Pharmacists conducted consultation again and suggested adjusting the dosage of meropenem (2 g, intravenous drip, q8h) while continuing the combined use of vancomycin. On the 15th day after surgery, the patient still had occasional low-grade fever. Physicians invited clinical pharmacists for consultation, and pharmacists suggested discontinuing vancomycin and administering linezolid (600 mg, intravenous drip, q12h) while continuing the combined use of meropenem for anti-infective treatment. After that, the patient's symptoms further improved. On the 22nd day after surgery, the patient was conscious, had clear vision and normal body temperature, and was allowed to be discharged from hospital by physicians. Conclusion: Clinical pharmacists participate in the whole course of postoperative intracranial infection treatment in this patient with intracranial space-occupying lesion. Based on the changes of his condition, they put forward rational suggestions by combining pharmaceutical expertise with relevant guidelines and conducted pharmaceutical care. The patient has achieved good curative effect, which reflects the professional value of clinical pharmacists.

Objective: To analyze the adverse reaction identification and management process of rash induced by oral vancomycin in the treatment of Clostridium difficile (CD) infection in a patient with ulcerative colitis, and provide a reference for improving drug safety information, optimizing clinical treatment regimens and ensuring the medication safety of patients. Methods and Results: A female patient was admitted to the hospital for the treatment of "ulcerative colitis". On the first day of admission, she was given symptomatic treatment with mesalazine enteric-coated tablets, live combined Bacillus subtilis and Enterococcus faecium enteric-coated capsules, ceftriaxone sodium for injection, etc. On the third day of admission, colonoscopy and laboratory tests indicated that the patient was complicated with CD infection. Therefore, ceftriaxone sodium was discontinued, and oral vancomycin was administered. Symmetric rashes appeared on the medial sides of both wrists and the elbows 3-4 hours after the first dose of vancomycin, which subsided spontaneously about 1 hour later without any intervention. However, rashes recurred after subsequent administrations of vancomycin, with the interval between medication intake and rash onset gradually shortened, and all rashes subsided spontaneously. Therefore, the rash was preliminarily identified as a vancomycin-related adverse reaction. On the following day, vancomycin was discontinued and replaced with metronidazole tablets, and no recurrence of rash was observed thereafter. Conclusion: Based on literature review, it is considered that the rash may be caused by the absorption of vancomycin into the blood. During the treatment of patients with CD infection, it is necessary to be alert to the adverse reactions of oral vancomycin, especially for patients with high risk factors, and monitoring and evaluation should be enhanced.

Objective: To analyze the diagnosis and treatment process of a patient with drug induced hypersensitivity syndrome (DIHS) caused by moxifloxacin, and provide a reference for ensuring the medication safety of patients. Methods and Results: A 37-year-old female patient was admitted to the hospital due to "cough with expectoration and shortness of breath for 2 days". After admission, left lower lobe pneumonia was confirmed by blood routine examination, chest computed tomography (CT) and other examinations. The patient's symptoms were relieved after empirical anti-infective treatment with the combined use of moxifloxacin and ceftizoxime. On the ⁹th day of admission, the patient developed diarrhea accompanied by fever, chills, general muscle and joint soreness. On the 11th day, the patient's body temperature reached 3⁹.1 ℃ with persistent diarrhea, and WBC count was 6.⁹1×10⁹/L. The pharmacist suspected an adverse drug reaction and suggested that the physician discontinued moxifloxacin. However, considering the possibility of being complicated with bacterial infection, the physician discontinued ceftizoxime and switched to cefoperazone-sulbactam sodium for treatment. On the 12th day, the patient still suffered from high fever and diarrhea, with scattered erythematous rashes on the neck. On the 13th day, the peak body temperature of the patient was 38.7 ℃, with multiple erythematous rashes all over the body. She reported general migratory pain during moxifloxacin infusion, with a pain score of 6-7 points. The pharmacist suggested discontinuing the suspected drug again, which was adopted by the physician. Moxifloxacin and cefoperazone-sulbactam sodium were discontinued, and symptomatic treatment was given. Two days after drug withdrawal, the patient's body temperature returned to normal, and the general rashes subsided compared with the previous condition. After 2 more days of continuous treatment, her condition improved and she was allowed to be discharged from hospital. Conclusion: Clinicians need to improve the understanding of DIHS, identify it early and discontinue the suspected drugs in a timely manner, so as to ensure the medication safety of patients and improve their prognosis.

Objective: To analyze the distribution and influencing factors of vancomycin serum trough concentration in pediatric patients, and provide a reference for optimizing vancomycin treatment regimens and improving the compliance rate of target trough concentration. Methods: A total of 55 pediatric patients who received vancomycin for injection and underwent serum trough concentration monitoring in Yulin Maternal and Child Health Care Hospital from October 2022 to February 2024 were selected as research subjects. The compliance status of their trough concentration was analyzed. Eight items of baseline data of the patients were collected, and univariate and multivariate Logistic regression analyses were performed respectively to identify the factors influencing the compliance of target trough concentration. Results: The average vancomycin trough concentration in 55 pediatric patients was (8.3⁹±6.34) μg/mL. 26 cases reached the target trough concentration (5-15 μg/mL), with a compliance rate of 47.27%. There was no statistically significant difference in the distribution of vancomycin trough concentration among different age groups (χ²=8.221, P=0.222). No statistically significant differences were observed in urea nitrogen, serum creatinine and glomerular filtration rate before and after vancomycin treatment (P>0.05). The results of univariate and multivariate Logistic regression analyses showed that serum albumin level and concomitant use of diuretics were independent influencing factors for the compliance of vancomycin serum trough concentration in pediatric patients (P<0.05). Conclusion: There are significant individual differences in vancomycin serum trough concentration among pediatric patients, with a low compliance rate of target trough concentration. Serum albumin level and concomitant use of diuretics are significantly correlated with the compliance of target trough concentration. In clinical practice, it is necessary to strengthen monitoring of target trough concentrations and renal functions during vancomycin treatment.

Objective: To analyze the clinical characteristics of pregnant patients infected with Listeria monocytogenes (LM) and provide a reference for improving the cognition, diagnosis and treatment of this disease. Methods: A total of 4 pregnant patients with LM infection admitted to Luoyang Central Hospital Affiliated to Zhengzhou University from July 2017 to November 2021 were selected as research subjects. Clinical data including age, gestational weeks, predisposing factors, onset season, laboratory tests, use of antibacterial drugs, and maternal and neonatal outcomes were extracted from the hospital electronic medical record system. The baseline data, clinical manifestations, laboratory findings, and maternal and neonatal outcomes of LM-infected patients were analyzed. Results: Among 4 patients, the gestational weeks were distributed in the first trimester (1 case), second trimester (2 cases) and third trimester (1 case). The onset was mainly in summer (3 cases), and all patients presented with fever. All of 4 patients received empirical treatment with cephalosporin antibacterials. Among them, 2 cases delivered stillbirths after the occurrence of uterine contractions, 1 case with twin pregnancy suffered from intrauterine fetal death, and 1 case gave birth to a live-born infant via emergency cesarean section (treatment was abandoned due to the critical general condition of the infant). Conclusion: The clinical manifestations of LM infection during pregnancy are non-specific, mostly manifested as fever, chills, sore throat, myalgia and abnormal fetal movement, which are prone to cause severe adverse pregnancy outcomes. In view of the insufficient coverage of the antibacterial spectrum in empirical anti-infective therapy, it is suggested that the department of obstetrics and department of infectious diseases should strengthen collaborative diagnosis and